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Malawi's hope for a future without AIDS

In 2004, Edith Thaulo administered antiretroviral drugs to Dignitas International's very first patient. Seven years later, she is happy to report that the man is still alive. Photo by Travis Lupick. 

By Travis Lupick

When Montreal’s Dr. James Orbinski was taken aback when he visited a hospital in Malawi in 2004.

“It was a living hell,” Orbinski writes in An imperfect Offering: Humanitarian Action in the Twenty-First Century. “My knees weakened as I looked around. The hospital was overrun with desperately sick patients. A hundred and fifty people were crammed into a ward that had only 30 beds. Sick people were lying under trees outside. Ninety-per cent of the sick were HIV-positive. It was not a hospital but a morgue.”

This experience inspired Orbinski and a colleague, James Fraser, to leave Doctors Without Borders in 2004 and start Dignitas International, a smaller NGO that would focus on community-based care for people living with HIV and AIDS.

Some seven years later, there’s good news to report from Malawi.

“I registered the first patient,” reported Edith Thaulo, head nurse of Tisungane Clinic at Zomba Central Hospital.

“And,” she continued, “he is still alive today.”

We met Thaulo as part of a tour of Tisungane Clinic ahead of World AIDS Day on Dec. 1.

Dignitas runs Tisungane in partnership with Malawi’s Ministry of Health. 

“The clinic started small with just a few staff and a few patients being followed here,” clinic coordinator Edson Mwinjiwa recounted. “Zomba didn’t have any ARV service and it is a big place, with 70,000 people and a high HIV-prevalence rate; about 17 per cent at that time.”

Since then, Mwinjiwa detailed, Dignitas has enrolled approximately 18,000 HIV-positive patients in antiretroviral treatment (of which 10,000 currently remain in the system and make regular visits to Dignitas clinics). And Zomba District’s HIV-prevalence rate has dropped from 17 to 10 – nearly two points below the national.

This wasn’t all accomplished at Tisungane Clinic, Mwinjiwa noted. A big part of Dignitas’ work in Zomba has consisted of capacity-building  – training staff to specialize in HIV/AIDS prevention, care, and treatment – throughout the district. In addition to these efforts, Dignitas also opened 22 satellite clinics, which has meant huge gains for ARV accessibility, Mwinjiwa emphasized.

Acknowledging Dignitas’ success, the Ministry of Health recently invited the group to expand into two additional districts –Phalombe and Mulanje – and after that, Malawi’s entire South-East Health Zone.

And so there is much to celebrate. However, Dr. Belete Assefa, Malawi country director for Dignitas International, called attention to recent funding problems that could put much of the progress Malawi has made at risk.

He noted that Malawi’s fight against HIV and AIDS is heavily dependent on funding provided through the Global Fund to Fight AIDS, Tuberculosis and Malaria, which, on Nov.24 and amid an economic downtown and accusations of financial mismanagement, announced that it would issue no new grants until 2014.

No one interviewed during a week of hospital visits was so bold as to claim that Malawi can actually get to a zero rate of HIV transmission by 2015.

But looking back over the last decade, the majority expressed great optimism for the direction in which the country’s fight against HIV and AIDS is headed.

Follow Travis Lupick on Twitter: @tlupick

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